- AARP - http://blog.aarp.org -
Will Court Block Insurers from Dropping Doctors?
Posted By Kaiser Health News On December 6, 2013 @ 5:57 pm In Bulletin Today,Personal Health | Comments Disabled
By Susan Jaffe, Kaiser Health News 
In a decision that could have national implications, a federal judge in Connecticut temporarily blocked UnitedHealthcare late Thursday from dropping an estimated 2,200 physicians from its Medicare Advantage plan in that state.
“This is very good news from Connecticut,” said Dr. Sam L. Unterricht, president of the Medical Society of the State of New York. “We will definitely seriously consider filing a suit in New York as well.”
The Ohio State Medical Association is also reviewing the decision, said Todd Baker, a spokesman for the Ohio State Medical Association.
The preliminary injunction issued  by U.S. District Court Judge Stefan Underhill comes less than 48 hours before a deadline at midnight tomorrow for seniors to choose a Medicare Advantage or drug plan for next year. Medicare officials said they don’t plan to extend the deadline for beneficiaries affected by the terminations, but will continue to monitor the situation. After the deadline, Medicare Advantage members are allowed to make one change from Jan. 1 through Feb. 14 — they can leave their plan and rejoin traditional Medicare.
UnitedHealthcare is the largest Medicare Advantage insurer in the country, with nearly 3 million members and is reducing its network of physicians  in at least nine other states More than 14 million older or disabled Americans are enrolled in Medicare Advantage plans, a managed care version of Medicare. Generally, it is an alternative to traditional Medicare that offers medical and usually drug coverage but members have to use the plan’s providers.
“We disagree with the ruling and intend to appeal it immediately,” said UnitedHealthcare spokesman Terry O’Hara. However, the company will comply with the order, while the appeal is underway.
The judge criticized the strategy to terminate the doctors: unilaterally amending the doctors’ contracts with a provision that canceled them. “United’s argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plan by amendment of that plan is not supported by the language of the contract or the parties’ experience under it,” Underhill wrote.
The Centers for Medicare & Medicaid Services , which oversees the Medicare Advantage program, is reviewing the provider changes by UnitedHealthcare to determine whether its plans have sufficient doctors to meet federal requirements.
Neither the agency nor the insurer would discuss that review, but the Connecticut doctors argued in court that the changes would harm patients.
“We won’t let UnitedHealthcare get away with interfering with the doctor-patient relationship,” said Dr. Robin Oshman, president of the Fairfield County Medical Association in a written statement. The lawsuit was brought by that and the Hartford County Medical Association.
Seniors advocates welcomed the ruling.
“Judge Underhill’s decision, at a minimum, shows private Medicare plans that they do not have unfettered license,” said Judith Stein, executive director of the Connecticut-based Center for Medicare Advocacy. “Federal courts have jurisdiction over Medicare Advantage actions to ensure the beneficiary rights are protected.”
Unterricht said he hopes UnitedHealthcare will reconsider the doctors’ terminations.
“This patient population is very fragile and requires stable medical care from physicians who know them and whom they know,” he said.
Also of Interest
See the AARP home page  for deals, savings tips, trivia and more
Article printed from AARP: http://blog.aarp.org
URL to article: http://blog.aarp.org/2013/12/06/will-court-block-insurers-from-dropping-doctors/
URLs in this post:
 Kaiser Health News: http://www.kaiserhealthnews.org/
 Image: http://blog.aarp.org/wp-content/uploads/2012/12/medicare-pill.jpg
 “Show Us Your Modern Family” Photo Contest. Upload your photo for a chance to be photographed in AARP The Magazine.: http://blog.aarp.org/2013/12/20/instagram-family-photo-contest/?intcmp=AE-BL-IL-MODFAMSWPS
 See official rules.: http://www.aarp.org/home-family/friends-family/info-12-2013/modern-family-photo-contest-rules.html
 The preliminary injunction issued: http://courtweb.pamd.uscourts.gov/courtwebsearch/ctxc/P4aXCeO6.pdf
 reducing its network of physicians: http://www.kaiserhealthnews.org/Stories/2013/December/01/Medicare-Advantage-UnitedHealthcare-narrow-networks-doctors.aspx
 Centers for Medicare & Medicaid Services: http://www.cms.gov/
 >> Get discounts on health products and services with your AARP Member Advantages.: http://discounts.aarp.org/savings/discounts/health-andamp;-wellness/uSource/HCTN/categoryId/724/subCategoryId/726?intcmp=AE-BL-HEA-DISC
 This article was produced by Kaiser Health News with support from : mailto:Jaffe.KHN@gmail.com
 The SCAN Foundation: http://www.thescanfoundation.org/
 Join in the discussion on Medicare on AARP’s online community.: http://www.aarp.org/online-community/groups/index.action?plckGroupId=Group1162&plckGroupPage=forum#plckforumpage=ForumDiscussion&plckdiscussionid=Cat%3AprivateForum%3Aebc11bf6-1e2e-450b-8145-66198c2eb054%40D%7C9%3B9%7CCommGroupGroup1162%7CDiscussion%3A8e4c8341-41d0-441c-99e3-1ae5d4dd3298&plckforumpostonpage=1&plckpostid=
 Medicare 101: A must-read guide to the basics: http://www.aarp.org/health/medicare-insurance/info-10-2013/medicare-for-dummies-patricia-barry.html?intcmp=AE-ENDART1-BL-REL
 5 Things your doctor dislikes about you: http://www.aarp.org/health/doctors-hospitals/info-12-2011/doctor-patient-complaints.html?intcmp=AE-ENDART2-BL-BOS
 Questions about the Affordable Care Act? Get your answers here.: http://healthlawanswers.aarp.org/?intcmp=AE-ENDART3-BL-ADV
 Join AARP: https://appsec.aarp.org/MSS/join/application?intcmp=AE-ENDART3-BL-MEM
 AARP home page: http://www.aarp.org/?intcmp=AE-ENDART3-BL-HP
Copyright © 2013 AARP. All rights reserved.